Healthcare Provider Details

I. General information

NPI: 1952456667
Provider Name (Legal Business Name): E.O. LAB INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 MONROE AVE
ROCHESTER NY
14618-4601
US

IV. Provider business mailing address

2929 MONROE AVE
ROCHESTER NY
14618-4601
US

V. Phone/Fax

Practice location:
  • Phone: 585-442-0123
  • Fax: 585-442-1096
Mailing address:
  • Phone: 585-442-0123
  • Fax: 585-442-1096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD LYNN LEVY
Title or Position: PRESIDENT
Credential: OPTICIAN
Phone: 585-442-0123